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Somatosensory training for postural control in independent-living individuals with Parkinson’s disease

Gregory, Tania (2015-12)

Thesis (MSc)--Stellenbosch University, 2015.

Thesis

ENGLISH ABSTRACT: Introduction: Postural control (PC) impairments in Parkinson’s disease
(PD) involve proprioceptive processing and integration deficits. Although
deficits in proprioception have a negative effect on PC, the precise contribution
to postural instability in PD remains unclear. The somatosensory system
incorporates both the proprioceptive and haptic feedback systems, and by applying
light touch postural sway (PS) can be improved in individuals with PD.
The study therefore aimed to determine if an eight-week somatosensory training
program (SSTP) would influence PC in individuals with mild to moderate
PD.
Study design: Time-series experimental study design.
Methods: Thirty-seven participants with idiopathic PD (67 9 years; H&Y:
2 1; MDS-UPDRS III: 28 14) were divided into two groups i.e. somatosensory
training group (EXP; n = 24) and placebo group (PBO; n = 13). Primary
outcome measures included joint position sense (JPS), sensory integration
(mCTSIB), Timed-Up-and-Go (TUG), fear of falling (FES-I) and PS.
Secondary outcome measures were quality of life (PDQ-39 SI), part II, III and
total score of Movement Disorder Society-Unified Parkinson’s Disease Rating
Scale (MDS-UPDRS) and balance confidence (ABC). Participants were tested
on medication, at baseline, pre- and post-intervention over a period of 16-
weeks. JPS was tested at the ankle joint with the Active Movement Extent
Discrimination Apparatus (AMEDA) at 10°, 11°, 12°, 13° and 14°. For the
modified Clinical Test of Sensory Integration and Balance (mCTSIB) and PS
with and without haptic feedback, the Instrumented Sway tri-axial accelerometer
was used to assess overall PS during eight conditions i.e. eyes open (EO), eyes closed (EC), both off and on a foam pad (+F) as well as all four conditions
with haptic feedback.
Results: A statistically significant treatment effect was found in the EC+F
(p = 0.0002), TUG (p = 0.0001), FES-I (p = 0.02), part III (p = 0.02), as
well as in total score of MDS-UPDRS (p = 0.02) for the EXP group. The
EXP group improved in JPS (p = 0.02), EC+F JERK (p = 0.002) and RMS
(p = 0.01) as well as PDQ-39 SI (p = 0.03) after the intervention. The EXP
group showed a significant improvement in the TUG before and after the Treatment
phase (p < 0.05). The EXP group also showed a significant improvement
for EC+F JERK (p = 0.002) and TUG (p = 0.01), with a strong tendency
for better balance confidence (p = 0.07), compared to the PBO group. Both
groups presented with reduced sway amplitude when receiving haptic feedback
compared to no manual contact, regardless of the surface area (p < 0.01). However,
no group differences were found during the Baseline and Treatment phase
(p > 0.05).
Conclusion: The positive findings of this study provide evidence that this
SSTP could improve PC in PD individuals. However, haptic feedback cannot
be altered by a SSTP, but it can improve PS in individuals with PD, regardless
of the surface area.